| NPI | 1639817760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER BOLYARD Operations Manager 443-570-0988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 261QM0855X Clinic/Center, Adolescent and Children Mental Health |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-05-27 |